2-day caths?

[smf0903]

So our facility relatively recently started doing interventional caths. We had a cardiologist covering for our normal ones, and performed a diagnostic cath on a patient. The cardiologist then went back in the second day because he “decided” to do an intervention (no changes, highest occlusion was 60%). When I questioned this I was told “most places do diagnostic cath on one day and then go back the next day to do any interventions”. Is that true?? What exactly is the reasoning behind that if it is? In my eyes that’s just double-billing, for lack of any other reason i can think of. I would love to know the rationale behind this (I asked, the doc simply said he “decided” overnight to take the patient back the following day...no one else can give me a reason why a facility would do caths this way).

Thanks ahead of time for your input! ?

[dianah, ASN]

Gosh, we are so hard-pressed for time slots in the cath lab, I can't imagine our docs doing anything like that! If the patient's condition worsens they may opt to go back in to see if anything has changed.

If there is a questionable lesion, the interventionalist uses FFR or OCT to fully and objectively evaluate flow. If flow test indicates, and patient is symptomatic, PCI is done.

Am interested to see what other responses you get.

[MunoRN, RN]

No, that's not normal, it's hard not to guess that it might have something to do with the ability to bill for a diagnostic and interventional cath separately. In my experience, the only time where the two would just being separate procedures would be where a surgical (bypass) would be needed to decide best options, where the patient/family wants to get the diag cath results first and then have time for decision making.

I would report this to your facilities compliance staff.

[offlabel]

Quote

“most places do diagnostic cath on one day and then go back the next day to do any interventions”

The cardiologist told you this? If it happens, it isn't a matter of routine. It'd be unusual in an out of the ordinary circumstance.

[smf0903]

8 minutes ago, offlabel said:

The cardiologist told you this? If it happens, it isn't a matter of routine. It'd be unusual in an out of the ordinary circumstance.

Yes! To say I was floored is an understatement. I said that it was the most asinine thing I’d ever heard.

[smf0903]

Thanks you guys, I guess I’m not crazy then LOL I thought that was the stupidest thing I’d ever heard. I said I’d be mad as all get out if I was a patient and not only had to go through the procedure twice but to get billed twice too?! I understand that on occasion there may be an issue when they have to go back in but as a matter of routine this sounds like borderline insurance/billing fraud.

I appreciate your replies! ?

[klight]

I’ve been a cath lab nurse for over 10 years and this is definitely unethical and only purpose is to make more $. Also all research shows anything less than 70% blocked should be treated medically and not stented. Poor patient.

[CCU BSN RN]

The interventional cardiologist was unclear if he should stent the lesion. He went home and did some aggressive googling or asked one of his superiors to review the images. The decision was apparently to intervene on the lesion, so the patient was brought back the next day. When you asked, he felt stupid and got defensive and did not want to admit his stupidity. So he lied to you. Unlikely due to billing because he likely isn't being paid by the procedure, so he would have to be really gung-ho about earning the hospital more money at the patient's expense.